title: Left atrial enlargement and reduced atrial compliance occurs early in Fabry cardiomyopathy.
abstract: BACKGROUND
  Fabry disease is associated with left ventricular hypertrophy (LVH) and myocardial fibrosis. The aim of this study was to evaluate left atrial (LA) size and function using tissue Doppler-derived strain in patients with Fabry disease.
  
  
  METHODS
  Echocardiography was performed in 33 Fabry patients (14 without LVH, 19 with LVH) before commencement of enzyme replacement therapy, and results were compared with those from age-matched and gender-matched controls (n=28 and n=38, respectively). Atrial strain and strain rate were measured from four segments in the apical four-chamber and two-chamber views of the LA, and global values were calculated. Systolic strain, systolic strain rate, early diastolic strain rate, and late diastolic strain rate were measured. Phasic LA volumes and fractions were calculated. Mitral inflow and tissue Doppler E' velocities were used to estimate left ventricular (LV) diastolic function.
  
  
  RESULTS
  LA volume was increased in Fabry patients, even in the absence of LVH. Importantly, diastolic function was normal in this subgroup without LVH, with E' velocities similar to those in controls. LA systolic strain and early diastolic strain rate were selectively reduced in Fabry patients with LVH and reflect reductions in LA and LV relaxation, respectively, consequent to increased LV mass. However, independent of LVH, both Fabry groups had significant reductions in systolic strain rate and increased LA stiffness index.
  
  
  CONCLUSIONS
  Fabry disease is associated with LA enlargement and reduced atrial compliance that occurs before the development of LVH. This suggests that Fabry cardiomyopathy may not only cause ventricular hypertrophy and fibrosis but also alters atrial myocardial properties early in the disease process. Consequently, measurements of LA size and function may be useful in the early diagnosis of Fabry disease, before the development of LVH.
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia.
authors.forename: Anita C
authors.initials: AC
authors.lastname: Boyd
authors.forename: Queenie
authors.initials: Q
authors.lastname: Lo
authors.forename: Kerry
authors.initials: K
authors.lastname: Devine
authors.forename: Michel C
authors.initials: MC
authors.lastname: Tchan
authors.forename: David O
authors.initials: DO
authors.lastname: Sillence
authors.forename: Norman
authors.initials: N
authors.lastname: Sadick
authors.forename: David A B
authors.initials: DA
authors.lastname: Richards
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D055119:Elastic Modulus; D000795:Fabry Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013718:Tensile Strength; D014463:Ultrasonography; D014655:Vascular Resistance
keywords: A sr; Atrium; Cardiomyopathy; E sr; Early diastolic strain rate; Echocardiography; Fabry disease; LA; LV; LVEF; LVH; Late diastolic strain rate; Left atrial; Left ventricular; Left ventricular ejection fraction; Left ventricular hypertrophy; S sr; Systolic strain rate